VERTEBRAL HEART SCORES IN EIGHT DOG BREEDS

K. JEPSEN-GRANT, R.E. POLLARD, L.R. JOHNSON

The vertebral heart score (VHS) measurement is commonly used to provide a more objective measurement
of cardiomegaly in canines. However, several studies have shown significant breed variations from the value
previously established by Buchanan and Bücheler (9.7 ± 0.5). This study describes VHS measurements in Pug,
Pomeranian, Yorkshire Terrier, Dachshund, Bulldog, Shih Tzu, Lhasa Apso, and Boston Terrier dog breeds.
Dogs with two or three view thoracic radiographs, no subjective radiographic evidence of cardiomegaly, and
no physical examination findings of heart murmurs or gallop rhythms were included in the study. The Pug,
Pomeranian, Bulldog, and Boston Terrier groups were found to have a VHS significantly greater than 9.7 ±
0.5 (P < 0.00001, P = 0.0014, P < 0.0001, P < 0.00001, respectively). Body condition score (BCS) was found
to have a significant effect on the VHS of Lhasa Apso group. Anomalous vertebrae in the thoracic column were
associated with a significant increase in VHS of the Bulldog (P = 0.028) and Boston Terrier (P = 0.0004)
groups. Thoracic depth to width ratio did not have a significant effect on VHS. C 2012 Veterinary Radiology

& Ultrasound.

Key words: brachycephalic, canine, chondrodystrophic, vertebral heart score, VHS.

Introduction icant differences in left vs. right lateral radiographs.1 In a

study evaluating VHS of dogs under anesthesia, the VHS

T HE VERTEBRAL HEART SCORE (VHS) measurement has

been described as a more objective method for assess-
ing cardiomegaly in dogs. The measurement is based on
cardiac height and width and is normalized to overall body
size by comparison to vertebral body length.1 The origi-
nal report of VHS measurements made by Buchanan and
Bücheler evaluated 100 normal dogs representing a variety
of breeds and established a reference range of 9.7 ± 0.5 ver-
tebral bodies.1 Since the original report, other studies have
described breed-specific differences in this VHS reference
range for Beagles, Greyhounds, and Whippets.2–6
Additional studies have shown that nonprimary cardiac
disease or changes in diagnostic technique can alter VHS
measurement. In one previous study, cats with severe ane-
mia showed a trend toward increased VHS in comparison
to the normal VHS established in cats.7 It was suggested
that this trend was due to the activation of neuroendocrine
compensatory mechanisms (such as the renin-angiotensin-
aldosterone system) leading to sodium and water retention
and volume overload. Two previous studies found that val-
ues from right lateral radiographs were significantly greater
than VHS values from left lateral radiographs.2, 8 The orig-
inal paper by Buchanan and Bücheler identified no signif-
From the Department of Surgical and Radiological Sciences (Pollard),
the Department of Medicine and Epidemiology (Johnson), Veterinary
Medical Teaching Hospital, University of California, Davis, CA 95616
(Jepsen-Grant).
Address correspondence and reprint request to R.E. Pollard, at the
above address. E-mail: repollard@ucdavis.edu
Received March 23, 2012; accepted for publication July 13, 2012.
doi: 10.1111/j.1740-8261.2012.01976.x
of manually ventilated dogs was smaller than the VHS of
dogs with spontaneous ventilation.9 A previous study has
shown that the VHS of male dogs was greater than that of
females.5
A recent study evaluating airway collapse in small breed
dogs with mitral regurgitation revealed that some dogs
had a calculated VHS exceeding the normal range despite
having normal cardiac dimensions on echocardiography.10
Findings suggested that published reference ranges for VHS
may not be applicable to small breed dogs. We hypothesized
that the reference ranges for VHS of small breed, chon-
drodystrophic, or brachycephalic dogs would be higher
than the published reference range of 9.7 ± 0.5 thoracic
vertebrae.1 If true, results of this study could help reduce
false positive radiographic diagnoses of cardiomegaly in
these dog breeds.
Materials and Methods
Medical records at the University of California, Davis
William R. Pritchard Veterinary Medical Teaching Hos-
pital were searched for Pugs, Pomeranians, Yorkshire Ter-
riers, Dachshunds, Bulldogs, Shih Tzus, Lhasa Apsos, or
Boston Terriers that had 2 or 3-view thoracic radiographs
performed using a digital radiography system (Sound-
Eklin, Carlsbad, CA) between January 1, 2006 and Jan-
uary 1, 2011. Inclusion criteria for the study were: age >
1.5 years, no record of a heart murmur or gallop sound
Vet Radiol Ultrasound, Vol. 00, No. 0, 2012, pp 1–6.

1
2 JEPSEN-GRANT ET AL. 2012

breed, dogs were grouped as having a low (1–5) or high

(6–9) body condition score based on previously published
criteria.11
Thoracic depth to width ratio was calculated for each dog
to determine the shape of the thorax for each dog.1 Depth
was assessed on the right lateral radiographic view from the
dorsal margin of the xiphoid process to the ventral margin
of the vertebral body, with the electronic calipers aligned
perpendicular to the vertebral column (Fig. 2A). Width of

FIG. 1. Demonstration of VHS measurement in a dog with a VHS of 9.4.

detected on thoracic auscultation, and a radiographic re-

port describing subjectively normal cardiac size. A random
number generator was used to select a subset of 30 dogs
from each breed that fit the inclusion criteria. The Bulldog
category included French and English Bulldogs, as well as
dogs whose breed was noted only as Bulldog. If the cardiac
silhouette margins were obscured (i.e., by pleural effusion
or alveolar lung pattern), that dog was removed from the
study and another was selected from the database using
the random number generator. Medical records of selected
dogs were reviewed to extract body weight, body condi-
tion score (from 1–9), age at radiographic examination, and
gender when available. If echocardiography was performed,
results were also recorded.
The VHS for all dogs was calculated as previously de-
scribed (Fig. 1).1 Electronic calipers were used to obtain
dimensions of the long and short axis of the heart for com-
parison to the number of vertebral bodies, starting at tho-
racic vertebra number 4 (T4). A single observer (KJG) per-
formed all VHS measurements, and was aware of patient
signalment, physical examination results, and prior radio-
graphic assessment. Using a right lateral radiographic view
(except where noted), the long axis of the heart was mea-
sured from the ventral border of the carina to the most
distant ventral contour of the heart, excluding any distance
that had the radiographic opacity of fat. The short axis of
the heart was determined perpendicular to the long axis at
the level of the caudal vena cava and excluding any distance
that had the radiographic opacity of fat. Measurements of
both long and short axis were positioned over the thoracic
vertebra, starting at T4 and the number of vertebra spanned
was estimated to the nearest 0.1 vertebral body length. Ad-
dition of the two measurements resulted in the calculated
vertebral heart score. The presence of hemi-vertebrae or FIG. 2. (A) Thoracic depth measurement, from the xiphoid process to the
perpendicular of the vertebral column.
abnormally shaped vertebrae within the thoracic vertebral (B) Thoracic width measurement, measured from the insides of the 8th
column was recorded during data collection. Within each ribs.
VOL. 00, NO. 0 VERTEBRAL HEART SCORES IN EIGHT DOG BREEDS 3

the thorax was measured on a dorsoventral radiograph as
the distance between the medial borders of the eight ribs
(Fig. 2B). Dogs with a depth to width ratio < 0.75 were
determined to have a barrel chest, while those with a depth
to width ratio of > 1.25 were determined to have a deep
chest.
Statistical Analysis
All statistical tests were selected and performed by the
third author (L.R.J.). For all analyses, statistical testing was
performed using GraphPad Prism (Version 5 San Diego,
CA) and P < 0.05 was considered significant. Data were
assessed for normality using the D’Agostino & Pearson
omnibus test and expressed as mean ± standard deviation
(SD).12 Mean VHS measurements were compared among
dog breeds using analysis of variance. This analysis was
repeated following exclusion of dogs with hemivertebrae.
To assess effects of obesity, mean VHS measurements were
compared between dogs with low (1–5) vs. high (6–9) Body
condition score (BCS) within each breed using the Student’s
t-test. Mean VHS for each breed was compared to the pub-
lished mean reference value (9.7) by use of a one-sample
t-test. The number and percentage of dogs in each group
with mean VHS > 2 SDs above the established reference
range of 9.7 ± 0.5 was also calculated. Linear regression
was used to assess the correlation between thoracic depth
to width ratio and mean VHS within each breed.
Results
The sample population consisted of the following
dogs: 30 Pugs, 18 Pomeranians, 30 Yorkshire Terriers, 29
Dachshunds, 30 Bulldogs, 30 Shih Tzus, 18 Lhasa Ap-
sos, and 19 Boston Terriers. Clinical data on age, sex,
body weight, and body condition score are summarized in
Table 1. There was no significant difference in mean age
among the dog breeds analyzed. Mean BCS differed signif-
icantly between Pugs (6.0 ± 1.6) and Lhaso Apsos (4.6 ±
1.4), P < 0.0036.
Left lateral radiographs were used for VHS calculation
in 1 Pomeranian (VHS of 11.3) and 1 Bulldog (VHS of
12.6). Right lateral radiographs were used for all other
calculations. Mean and SD values for BCS and VHS are
summarized, by breed group, in Table 1; and demonstrated
graphically in Fig. 3. Mean VHS for Pug, Pomeranian,
Bulldog, and Boston Terrier breed groups were signifi-
cantly greater than the published reference VHS of 9.7 (P <
0.00001, P = 0.0014, P < 0.0001, P < 0.00001, respectively).
Numbers of dogs within each breed group that had a VHS
more than two SD above the published reference VHS are
summarized in Table 1. Two Pugs (VHS of 14.1 and 11.1)
and 1 Boston Terrier (VHS of 11) had echocardiograms
that were assessed as normal.
Thoracic hemivertebrae were identified in 2 Pugs, 13 Bull-
dogs, and 7 Boston Terriers. When VHS was recalculated
after removal of these dogs, the breed mean VHS remained
statistically different from the established value of 9.7 ±
0.5 (all P < 0.0001). Mean VHS for Bulldogs and Boston
Terriers with normal vertebrae were statistically different
from those with abnormal vertebrae (P = 0.028 and 0.0004,
respectively) (Table 2).
Effects of body condition score on VHS are summarized
in Table 3. A significant effect was identified in the Lhaso
Apso breed, with a higher VHS in high BCS group dogs
(10.5 ± 0.6) vs. low BCS group dogs (9.4 ± 0.6), P = 0.007.
Body condition score had a significant (P = 0.015), but
weak correlation (R2 = 0.03) with VHS across all dog breeds
(Fig. 4).

TABLE 1. Signalment Descriptions within Each Breed Group, Mean BCS and VHS for Each Breed Group, and Comparisons Between Breed Mean VHS
vs. the Published Reference VHS of 9.7

Age (years) P Value # Dogs % Dogs

M/F (mean ± SD) Weight (kg) BCS VHS (Breed VHS vs.) with VHS>2SD with VHS>2SD
(N) (range) (mean ± SD) (mean ± SD) (mean ± SD) reference) vs. reference vs. reference
Pug 11/19 6.9 ± 3.8 9.1 ± 2.7 6.0 ± 1.6 10.7 ± 0.9 <0.00001 13 43%
(1.5–14)
Pomeranian 9/9 7.4 ± 3.5 4.5 ± 2.4 5.5 ± 1.7 10.5 ± 0.9 0.0014 9 50%
(2–13)
Yorkshire Terrier 14/16 7.6 ± 4.3 3.2 ± 1.5 4.9 ± 1.4 9.9 ± 0.6 0.104 4 13%
(2–15.5)
Dachshund 11/18 6.8 ± 3.6 6.9 ± 2.8 5.8 ± 1.3 9.7 ± 0.5 0.788 2 7%
(2.5–13.5)
Bulldog 21/9 5.7 ± 3.2 26.7 ± 13.2 5.8 ± 1.2 12.7 ± 1.7 <0.0001 28 93%
(2–14)
Shih Tzu 9/21 6.5 ± 2.0 6.5 ± 2.0 5.1 ± 1.4 9.5 ± 0.6 0.059 0 0%
(1.5–13)
Lhasa Apso 9/9 7.4 ± 4.3 8.2 ± 3.2 4.6 ± 1.4 9.6 ± 0.8 0.57 1 6%
(2–15)
Boston Terrier 8/11 6.2 ± 3.2 8.9 ± 2.6 5.0 ± 0.9 11.7 ± 1.4 <0.00001 14 74%
(2–13)

M, male; F, female; N, number of dogs in each gender.

4 JEPSEN-GRANT ET AL. 2012

FIG. 4. A significant (P = 0.015) but weak (R2 = 0.03) correlation was

found between BCS and VHS in all dogs.

marized in Table 5. In the Yorkshire Terrier breed, mean

FIG. 3. Graphical representation of VHS measurements, with mean of
each breed represented by the individual black lines. The highlighted box
represents the reference value of 9.7 ± 0.5.
All dog breed groups had individuals with a barrel-
shaped chest conformation (ratio <0.75), including 53%
of Pugs and 80% of Yorkshire Terriers (Table 4). No signifi-
cant correlation between VHS and thoracic depth to width
ratio was identified for any breed group.
Dogs within each breed were then divided into male and
female groups and mean VHS between gender groups were
compared. Values for each breed and gender group are sum-
VHS for females was greater than for males (P = 0.01). No
other differences were identified.
Discussion
Findings from this study indicated that Pugs, Pomera-
nians, Bulldogs, and Boston Terriers without clinically
apparent cardiac disease had significantly greater VHS
values than the reference range of 9.7 ± 0.5 established
by Buchanan and Bücheler.2–6 In particular, the majority
of Bulldogs had a VHS exceeding 12.0. One possible
explanation for an increased VHS in chondrodystrophic
dogs could be an artifactual increase in the number of

TABLE 2. Comparisons Between Mean VHS for Normal vs. Abnormal Vertebrae Groups, within Bulldog and Boston Terrier Breeds

Normal VHS 1 Abnormal VHS 2 P value

vertebrae (N) (mean ± SD) vertebrae (N) (mean ± SD) (VHS 1 vs. 2)
Bulldog 17 12.1 ± 1.5 13 13.4 ± 1.6 0.028
Boston Terrier 12 11.4 ± 1.2 7 14.2 ± 1.6 0.0004

N = Number of Dogs in Each Vertebral Classification Group for Each Breed; VHS 1, VHS for Dogs with Normal Vertebrae; VHS 2, VHS for Dogs with
Abnormal Vertebrae.

TABLE 3. Comparisons Between Mean VHS for Low vs. High BCS Groups, Within Breeds

BCS 1–5 VHS 1 BCS 6–9 VHS 2 P value

(N) (mean ± SD) (N) (mean ± SD) (VHS 1 vs. 2)
Pug 12 10.43 ± 0.58 19 10.95 ± 1.08 0.1307
Pomeranian 7 10.16 ± 0.95 10 10.82 ± 0.68 0.1139
Yorkshire Terrier 17 9.77 ± 0.59 9 9.86 ± 0.53 0.705
Dachshund 14 9.74 ± 0.61 11 9.69 ± 0.45 0.789
Bulldog 11 12.59 ± 1.64 17 12.73 ± 1.81 0.838
Shih Tzu 17 9.51 ± 0.59 11 9.4 ± 0.5 0.62
Lhasa Apso 13 9.37 ± 0.63 4 10.5 ± 0.634 0.007
Boston Terrier 13 11.98 ± 1.57 3 10.67 ± 0.49 0.1851

N, Number of Dogs in Each BCS Classification Group for Each Breed; VHS 1, VHS for Dogs with BCS 1–5; VHS 2, VHS for Dogs with BCS 6–9.
VOL. 00, NO. 0 VERTEBRAL HEART SCORES IN EIGHT DOG BREEDS 5

TABLE 4. Thoracic Depth to Width Ratios for Each Breed Group and likely inevitable. To assess the effect of pericardial fat on
Percentage of Dogs Within Each Group Meeting Published Criteria for
Barrel-Shaped Chest Conformation (Ratio <0.75)
VHS, we compared VHS in dogs with low/normal BCS
vs. those of dogs with higher BCS. With the exception of
Thoracic depth: the Lhasa Apso, the breed with the lowest BCS overall in
N width ratio SD % < 0.75
this study, no significant differences were detected in VHS
Pug 30 0.75 0.8 53%
Pomeranian 18 0.75 0.08 44%
between dogs with low vs. high BCS. Although VHS was
Yorkshire Terrier 30 0.7 0.07 80% correlated with BCS, it was a very weak correlation and
Dachshund 29 0.83 0.07 10% considered unlikely to be of clinical significance.
Bulldog 30 0.77 0.1 33%
Shih Tzu 30 0.79 0.06 23%
We performed a correlation analysis between VHS and
Lhasa Apso 18 0.8 0.08 17% the thoracic depth to width ratio to determine whether a
Boston Terrier 19 0.78 0.07 37% barrel chested vs. deep chested conformation was responsi-
N, Number of Dogs in each Breed Group; SD, Standard Deviation for
ble for a significant portion of the variation in VHS among
Thoracic Depth: Width Ratio Within Each Breed Group. breeds. No significant correlation was identified. The high-
est proportion of barrel-chested dogs (thoracic depth to
width ratios of <0.75) were in the Yorkshire Terriers (80%)
TABLE 5. Comparisons Between Mean VHS for Males and Females and Pugs (53%). No dog in this study was identified as hav-
Within Each Breed Group ing a deep chest (ratio >1.25), which may have impacted
P value our ability to establish a correlation of VHS to thoracic
M/F Male Female (Male VHS vs. shape.
(N) VHS VHS Femal VHS)
One limitation of our study design was that we did not an-
Pug 11/19 10.5 ± 0.7 10.8 ± 1.0 0.51 alyze effects of noncardiac-related diseases, anesthesia, or
Pomeranian 9/9 10.3 ± 0.95 10.6 ± 0.8 0.45
Yorkshire Terrier 14/16 9.6 ± 0.4 10.2 ± 0.7 0.01 medical interventions, or whether right lateral radiographs
Dachshund 11/18 9.7 ± 0.36 9.7 ± 0.6 0.81 were different from left lateral radiographs. Another limita-
Bulldog 21/9 12.6 ± 1.7 12.9 ± 1.8 0.62 tion of our study was small sample size. Due to the presence
Shih Tzu 9/21 9.3 ± 0.6 9.6 ± 0.5 0.22
Lhasa Apso 9/9 9.9 ± 0.9 9.3 ± 0.6 0.12 of heart disease in many of the Lhasa Apso and Boston
Boston Terrier 8/11 11.6 ± 1.5 11.6 ± 1.5 1.0 Terriers that were examined during our study’s time frame,
only 18 and 19 dogs in these breed groups, respectively,
M, Male; F, Female; N, Number in Each Gender.
could be included. A larger sample size could possibly have
yielded different results. However, even with low numbers,
we were able to demonstrate that Boston Terriers had a
vertebrae spanned by cardiac measurements due to the significantly higher VHS than the reported reference value.
presence of hemivertebrae. When dogs with anomalous In the case of Bulldogs, both English and French bulldogs
vertebrae were removed from consideration, we found that were included in one group and evaluation of individual
the remaining dogs in some breeds persisted in having VHS of those specific bulldogs might have yielded differ-
greater VHS measurements compared with the original ent results. It is also possible that some of our dogs with a
VHS value of 9.7 ± 0.5. However, within the Bulldog subjectively normal heart size on radiographs actually had
and BostonTerrier breeds, VHS values were significantly occult heart disease, as only three of the dogs had echocar-
greater in dogs with abnormal vertebrae compared to diography performed to assess the structure and function
those with normal vertebrae. These findings indicate that of the heart. Underlying heart disease could therefore have
vertebral abnormalities may artifactually increase VHS skewed the VHS values higher than the reported normal.
in Bulldogs and Boston Terrier breeds but may not alter However, none of the included dogs had clinical evidence
VHS in other breeds. It is also possible that severe lordosis of a heart murmur or gallop rhythm.
or kyphosis of the vertebral column could skew alignment Findings from our study indicate that application of
of cardiac measurements and alter the measurement of a single, generic VHS measurement to small breed dogs,
VHS, however this factor was not investigated in our especially dogs with thoracic vertebral anomalies, could
study. Another factor affecting VHS in small breeds yield a false positive identification of cardiomegaly. A
could be breed-specific variations in vertebral body length high body condition score could also yield a false pos-
relative to overall body size. A study directed at assessing itive diagnosis of cardiomegaly, however overall correla-
vertebral body length compared to overall body size in tions between VHS and BCS were weak in our dogs.
multiple breeds would be necessary to further evaluate this Findings support the use of breed-specific VHS refer-
effect. ence ranges for objective measurements of cardiac size,
In this study, we attempted to exclude fat opacity from however comparisons to subjective radiographic assess-
cardiac measurements during original scoring, although ments of cardiac size and echocardiographic data are still
inclusion of some pericardial fat in the measurements was recommended.
6 JEPSEN-GRANT ET AL. 2012

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